The Factors of Pain and Pain Management after Transarterial Chemoembolization in Patients With Hepatocellular Carcinoma

Se Na Jung; Je In Seon; Kwang Sung Kim

doi:10.5388/aon.2017.17.2.107

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Jung, Seon, and Kim: The Factors of Pain and Pain Management after Transarterial Chemoembolization in Patients With Hepatocellular Carcinoma

Original Article

Asian Oncol Nurs 2017;17(2):107-115.

Published online: 5 June 2017

DOI: https://doi.org/10.5388/aon.2017.17.2.107

The Factors of Pain and Pain Management after Transarterial Chemoembolization in Patients With Hepatocellular Carcinoma

Se Na Jung¹, Je In Seon¹, Kwang Sung Kim²

¹Cancer center, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea.

²College of Nursing, Catholic University of Pusan, South Korea.

Address reprint requests to: Kim, Kwang Sung College of Nursing, Catholic University of Pusan, 57 Oryundae-ro, Geumjeong-gu, Busan 46252, Korea, Tel: +82-51-510-0776 Fax: +82-51-510-1576 E-mail: bmcoor@cup.ac.kr

Received 12 Apr 201715 Jun 2017 Accepted 20 Jun 2017

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

초록

Purpose

The purpose of this study was to identify the factors of pain and pain management after transarterial chemoembolization (TACE) in patients with hepatocellular carcinoma (HCC).

Methods

Participants were 99 inpatients with HCC who underwent TACE at C University in Seoul from May to October 2016. The instruments used in this study were the Numerical Rating Scale (NRS), the Pain Management Index (PMI), and the modified Patient Outcome Questionnaire (American Pain Society). The data were analyzed using SPSS 24.0, specifically descriptive statistics, t-test, ANOVA, and multiple regression.

Results

The percentage of patients who experienced pain after TACE was 66.7%. The mean pain score immediately after TACE was 4.43±2.36 and the highest score on average was 6.58±2.32. The pain score was highest at 5.24±5.67 hours after TACE. Significant factors influencing pain after TACE were the extent of embolization and the ECOG (Eastern Cooperative Oncology Group) score, which explained 26% of the variance in pain. PMI scores revealed that 33.3% of the participants were inadequately treated for pain.

Conclusion

In order to properly manage pain after TACE, medical staff need accurate understanding of pain and to administer the appropriate dosage of analgesics. The development of pain management protocol for patients who have undergone TACE would help achieve these goals.

Keywords: Hepatocellular Carcinoma, Transarterial Chemoembolization, Pain

REFERENCES

1. National Cancer Information Center (KR). Cancer statistics. mortality rate 2015 [Internet]. Available from. http://www.cancer.go.kr/mbs/cancer/subview.jsp?id=cancer_040201000000. [Accessed January 11, 2017].

2. National Cancer Center (KR). Cancer registration statistics 2010 [Internet]. Available from. http://www.ncc.re.kr/cancerstatsview.ncc?bbsnum=250&searchkey=total&searchvalue=&pagenum=1. [Accessed March 7,2016].

3. Han SH, Han SY, Go BS, Kim MJ, Lee JH, Koo YH, et al. Modified CLIP score as a new prognostic index for patients with hepatocellular carcinoma. Korean J Hepatol. 2006; 12:209–20.

4. Chung JW. Recent advance in international management of hepatocellular carcinoma. J Korean Med Assoc. 2013; 56:972–82.

5. Yoo SH, Bae SH. Complications associated with transcatheter arterial chemoembolization in patients with hepatocellular carcinoma. J Korean Liver Cancer Study Group. 2011; 11:144–8.

6. Lee KH, Kim DY, Kim JK, Chung HS, Kim JH, Paik YH, et al. The effect of preoperative transcatheter hepatic arterial chemoembolization in the treatment of hepatocellular carcinoma. Korean J Med. 2006; 70:17–25.

7. Jeong YH. Effective treatment of early diagnosis hepatocellular carcinoma. J Radiol Sci Technol. 2004; 27:5–11.

8. Hwang JS. Predisposing factors of complications in the treatment of hepatocellular carcinoma. Korean J Hepatol. 2007; 13:63–9.

9. Kim KH, Song EJ, Choi BK, Kim SB, Yang JH, Kim SH, et al. Prospective analysis of complications of transarterial chemolipiodolization in patients with hepatocellular carcinoma. Korean J Gastroenterol. 1999; 33:815–22.

10. Jee SR. Complications and risk factors after transcatheter arterial che-moembolizaion in the patients with hepatocellular carcinoma [dissertation]. Pusan: Pusan National Univ.;2000.

11. Cao W, Li J, Hu C, Shen J, Liu X, Xu Y, et al. Symptom clusters and symptom interference of HCC patients undergoing TACE: a cross-sec-tional study in China. Support Care Cancer. 2013; 21:475–83.

12. Kim MG, Kim HI, Yoon SH, Ko JG, Jeong JS, Han JS, et al. Evaluation of the effect of pain relief within the hepatic artery injection Lidocaine for reducing abdominal pains caused by TACE. J Korean Soc Interv Radiol. 2011; 14:199–205.

13. Zhou B, Wang J, Yan Z, Shi P, Kan Z. Liver cancer: effects, safety, and cost-effectiveness of controlled-release oxycodone for pain control after TACE. Radiology. 2012; 262:1014–21.

14. Prajapati HJ, Rafi S, El-Rayes BF, Kauh JS, Kooby DA, Kim HS. Safety and feasibility of same-day discharge of patients with unresectable hepatocellular carcinoma treated with doxorubicin drug-eluting bead transcatheter chemoembolization. J Vasc Interv Radiol. 2012; 23:1286–1293.el.

15. Jang YJ. Post operative pain of spinal surgery patients’ and satisfaction about intervention of pain control [dissertation]. Jeonju: Chonbuk National Univ.;2004.

16. Woo JS. Postoperative pains and the actual conditions of pain management and satisfaction with pain control for elderly operative patients [dissertation]. Pusan: Kosin Univ.;2007.

17. Kim NH. The effects of aromatherapy to reduce nausea vomiting and pain in patients receiving transcatheter arterial chemoembolization [dissertation]. Seoul: Kyunghee Univ.;2010.

18. Yun MJ, Min HS. The effects of position change on low back pain, discomfort, and bleeding after transarterial chemoembolization. Korean J Adult Nurs. 2014; 26:424–33.

19. Max MB, Donovan M, Miaskowski CA, Ward SE, Gordon D, Book-binder M, et al. Quality improvement guidelines for the treatment of acute pain and cancer pain. JAMA. 1995; 274:1874–80.

20. Kwon IG. Effects of education on pain management provided to cancer patients and medical personnel [dissertation]. Seoul: Seoul National Univ.;1999.

21. Lee SH, Hahn ST, Park SH. Intraarterial lidocaine administration for relief of pain resulting from transarterial chemoembolization of hepatocellular carcinoma: its effectiveness and optimal timing of administration. Cardiovasc Intervent Radiol. 2001; 24:368–71.

22. Malagari K, Pomoni M, Spyridopoulos TN, Moschouris H, Kelekis A, Dourakis S, et al. Safety profile of sequential transcatheter chemoembolization with DC Bead™: results of 237 hepatocellular carcinoma (HCC) patients. Cardiovasc Intervent Radiol. 2011; 34:774–85.

23. Jung EY, Eun SJ, Jeong BH, Lee YJ, Park DK. The design of the self-diagnosis algorithm for the efficient control of sudden cancer pain. J Korea Contents Assoc. 2014; 14:458–67.

24. Song SY, Kang BC, Rho K. Comparison of an additional transdermal fentanyl patch compared to intravenous NSAID and opioid analgesics within 24 hours of an uterine artery embolization for myoma and ade-nomyosis. J Korean Soc Radiol. 2011; 64:449–55.

25. Wáng YX, De Baere T, Idée JM, Ballet S. Transcatheter embolization therapy in liver cancer: an update of clinical evidences. Chin J Cancer Res. 2015; 27:96–121.

26. Leung DA, Goin JE, Sickles C, Raskay BJ, Soulen MC. Determinants of postembolization syndrome after hepatic chemoembolization. J Vasc Interv Radiol. 2001; 12:321–6.

27. Narayanan G, Barbery K, Suthar R, Guerrero G, Arora G. Transarterial chemoembolization using DEBIRI for treatment of hepatic metastases from colorectal cancer. Anticancer Res. 2013; 33:2077–83.

28. Feng YL, Ling CQ, Zhu DZ, Yu CQ, Chen Z, Li B. Ginsenosides com-bined with dexamethasone in preventing and treating postembolization syndrome following transcatheter arterial chemoembolization: a randomized, controlled and double-blinded prospective trial. Zhong Xi Yi Jie He Xue Bao. 2005; 3:99–102.

29. Yinglu F, Changquan L, Xiaofeng Z, Bai L, Dezeng Z, Zhe C. A new way: alleviating postembolization syndrome following transcatheter arterial chemoembolization. J Altern Complement Med. 2009; 15:175–81.

Table 1.

Difference in Pain by General Characteristics (N =99)

Characteristics	Categories	n (%) or M ± SD	Pain
Characteristics	Categories	n (%) or M ± SD	M ± SD	t or F	p
Gender	Male	73 (73.7)	4.60 ± 3.51	0.08	.938
	Female	26 (26.3)	4.54 ± 3.93
Age (year)	＜50	7 (7.1)	4.43 ± 3.21	0.53	.662
	50~59	18 (18.2)	5.44 _± 2.55
	60~69	40 (40.4)	4.63 ± 3.79
	≥70	34 (34.3)	4.12 ± 3.97
		65.9 ± 10.50
Classification of child-pugh	A	87 (87.9)	4.47 _± 3.57	0.60	.549
	B	11 (11.1)	5.64 ± 4.01
ECOG status	0	73 (73.7)	4.96 ± 3.47	1.74	.084
	1	26 (26.3)	3.54 ± 3.84
Number of tumor	1	41 (41.4)	4.54 _± 3.62	0.19	.901
	2	29 (29.3)	4.93 ± 3.59
	3	12 (12.1)	4.00 ± 4.07
	≥4	17 (17.2)	4.53 ± 3.50
		2.28 _± 1.60
Largest tumor diameter (cm)	≤3	72 (72.7)	4.32 ± 3.61	1.03	.360
	3.1~5	16 (16.2)	5.75 ± 3.45
	＞5	11 (11.1)	4.64 ± 3.75
		2.97 ± 2.62
Number of TACE (numbe	r) 1	32 (32.3)	4.84 ± 3.42	0.15	.858
	2~3	30 (30.3)	4.33 ± 3.96
	＞3	37 (37.4)	4.57 ± 3.54
		3.84 ± 3.46
Lipiodol dose (ml)	0	6 (6.1)	5.33 ± 4.46	0.15	.855
	1~9	49 (49.5)	4.61 ± 3.67
	≥10	44 (44.4)	4.45 ± 3.49
		8.32 ± 4.14
Procedure type	Conventiona	al 92 (92.9)	4.57 ± 3.61	-0.17	.868
	Drug-eluting	beads 7 (7.1)	4.78 ± 3.70
Location of mass	Right	46 (46.0)	4.96 ± 3.72	0.64	.531
	Left	17 (17.0)	3.82 ± 3.26
	Bilobar	36 (36.0)	4.47 ± 3.63
Extent of embolization	Tumor ^a	41 (41.4)	2.98 ± 3.34	9.43	＜.001
	Segment ^b ^c	32 (32.3)	6.34 ± 2.87		a＜ b,c∗
	Lobe ^c	26 (26.3)	4.96 ± 3.80
Doxorubicin dose (mg)	≤20	7 (7.0)	3.57 ± 3.40	0.22	.879
	30	54 (54.5)	4.57 ± 3.71
	40	13 (13.1)	4.69 ± 3.40
	50	25 (25.3)	4.84 ± 3.67
		35.56 ± 9.71

^∗ Scheffé test; ECOG₌ Eastern cooperative oncology group; TACE₌ Transarterial chemoembolization.

Table 2.

Pain Scores after TACE (N =99)

Variables	M ± SD	NRS = 0	NRS = 1~3	NRS = 4~7	NRS = 8~10
Variables	M ± SD	n (%)	n (%)	n (%)	n (%)
Immediately pain (NRS)	4.43 ± 2.36	53 (53.5)	20 (20.2)	21 (21.2)	5 (5.0)
Severe pain (NRS)	6.58 ± 2.32	30 (30.3)	8 (8.0)	32 (32.3)	29 (29.4)
Peak Time (hours)	5.24 ± 5.67

NRS₌ Numeric rating scale; TACE₌ Transarterial chemoembolization.

Table 3.

Influencing Factors on Pain (N =99)

Variables	Pain
Variables	B	SE	β	t	p	Tolerance	VIF
(Constant)	4.85	2.72		1.78	.078
ECOG (ref: 0) 1	-1.69	0.81	-.20	-2.07	.041	.85	1.17
Extent of embolization (ef: tumor) Segment Lobe	3.863.26	0.830.97	.50.39	4.623.34	＜.001.001	.72.61	1.381.63
Adj.R²=.26, F=2.55, p=.006

ECOG₌ Eastern cooperative oncology group.

Table 4.

Used Analgesics & PMI of Participants (N =99)

Variables	Drug	n (%)	MED (mg)	M ± SD	PMI score	n (%)
Mild opioid	Tramadoly∗	67 (60.3)	335		1	7 (7.1)
Strong opioid	Morphine∗	39 (35.1)	163	10.93 ± 8.28	0	59 (59.6)
	Pethidine∗	3 (2.7)	10		-1	22 (22.2)
	Fentanyl patch∗	2 (1.8)	49.6		-2	11(11.1)

^∗ Multiple response; PMI= Pain management index; MED= Morphine equivalent dose.

Table 5.

Patient Outcome Questionnaire (N =99)

Variables	Categories	n (%)
Experienced pain after	Yes	66 (66.7)
TACE	No	33 (33.3)
Reported pain after	Yes	43 (65.2)
TACE	No	23 (34.8)
Even with pain, reasons for	Thought I should be patient	18 (78.2)
not reporting pain to	Thought analgesics are not good for recovery	7 (30.4)
physician or nursey∗	Thought it does not look good for physician or nurse if I often complain of pain	1 (4.3)
After asked for analgesic	s, ≤10 minutes	34 (66.6)
time to wait to get it	11~20 minutes	8 (15.6)
	21~30 minutes	4 (7.8)
	31~60 minutes	1 (1.9)
	＞60 minutes	3 (5.8)
	Asked for medication but never received it	1 (1.9)
Satisfaction with	Very dissatisfied	3 (4.5)
pain control	Dissatisfied	8 (12.1)
	Slightly dissatisfied	3 (4.5)
	Slightly satisfied	11 (16.6)
	Satisfied	39 (59.1)
	Very satisfied	2 (3.0)
Reasons to be not satisfied with	Pain was not improve	9 (64.2)
pain control∗	Took a long time for the analgesics to be administered	3 (21.4)
	Only when I was reporting pain, controlled pain	2 (14.2)
	Did not explain how to use the analgesics and side effects	1 (7.1)
	Even though wanted analgesics, didn't get it	1 (7.1)

^∗ Multiple response; TACE= Transarterial chemoembolization.

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